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Member Scholarship Application Keystone First wants to help make your dream of college or a new career possible. Apply for the 2014 deadline for applications is March 17 2014. First Name Last Name Male Female Street Address County or Section of the City City Phone State Zip Code Major/Area of Study Email Address Age Part-Time High School Name and Address Full-Time Year Graduated College/University/Trade/Vocational School Name and Address either currently enrolled or plan to enroll Please list your extracurricular school activities or any volunteer activities. Please list any jobs full- or part-time you have held that have contributed to your educational goals. If you plan to move after March 1 2014 please include your forwarding address. Write a 1-page essay typed or neatly handwritten on a separate sheet of paper telling us why continuing your education is important to you. Please include the following points What you want to study and why. How your education will change your life. Why you need our help* What you plan to do with your education* I give my permission to use all or part of my essay and my photograph for publicity and/or advertising purposes. Signature of applicant OR signature of parent/guardian if under 18 years of age REMINDERS You must Be a current Keystone First member. completed 12th grade or have your GED by June 2014. Enclose a copy of your grades if you are graduating this year. Be enrolled in an accredited undergraduate college university trade or vocational school by August 2014 graduate studies excluded. Enclose a copy of your grades if you are already enrolled* Complete the entire application* Have Your completed application package must be postmarked by March 17 2014. All required materials postmarked after the deadline will not be considered for the scholarship* Please mail Date Type or write a 1-page essay that answers the questions listed on the application* Submit a letter of recommendation from a teacher guidance counselor clergy member community leader work supervisor or someone outside of your family who has known you for a number of years. 100 Stevens Drive Philadelphia PA 19113-1570 www. keystonefirstpa*com 100KF-1322-246 Coverage by Vista Health Plan an independent licensee of the Blue Cross and Blue Shield Association*. Apply for the 2014 deadline for applications is March 17 2014. First Name Last Name Male Female Street Address County or Section of the City City Phone State Zip Code Major/Area of Study Email Address Age Part-Time High School Name and Address Full-Time Year Graduated College/University/Trade/Vocational School Name and Address either currently enrolled or plan to enroll Please list your extracurricular school activities or any volunteer activities. Please list any jobs full- or part-time you have held that have contributed to your educational goals. Please list any jobs full- or part-time you have held that have contributed to your educational goals. If you plan to move after March 1 2014 please include your forwarding address. Write a 1-page essay typed or neatly handwritten on a separate sheet of paper telling us why continuing your education is important to you.

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